MEMBERSHIP APPLICATION FORM 2010

Please complete this form and send it to:

Max Walter

Membership Secretary

GT40 Enthusiasts Club Ltd

Oak Lodge E-mail address: membership@gt40enthusiastsclub.com

113 Wimborne Road West

Wimborne

Dorset

BH21 2DH

Name:........................................................	I wish to pay my subscription of £30:
Address..................................................... ..................................................................	By cheque, payable to GT40 ENTHUSIASTS CLUB
.................................................................. ..................................................................	Charge my (Amex/MasterCard/VISA or Switch/Maestro only) Number:........................................................ Start Date:.................... Expiry Date: .................. Issue No: ...... Card CVS No (Last 3 digits):.......
..................................................................
Membership Number:................................

Signed................................................................................... Date...........................................

Useful Information

Phone:	Home.........................................................................
	Work.........................................................................
	Fax............................................................................
	Mobile.......................................................................
E mail Address	..................................................................................
Occupation	..................................................................................
Specialist Skills	..................................................................................

OFFICE USE D’base Entry ........................... Starter Pack....................... B/S No....................

WEBSITE

GT40 ENTHUSIASTS CLUB LTD

CAR DATA FORM

Please complete this form for our records.

The Club is keeping an historical record of cars in the Club. It would be helpful if you would send some photos for the book when returning the form. They can also be e-mailed direct to TimGT40Club@aol.com.

Name:................................................................................ Membership No:............................
Chassis Make e.g. GTD/KVA/TORNADO/RF	.......................................................................................
Bodyshell Make (as above)	.......................................................................................
Type: MK 1,2,3,4	.......................................................................................
Colour Scheme	.......................................................................................
Engine (brief specification)	....................................................................................... .......................................................................................
Gearbox (make & type)	.......................................................................................
Carburettor/fuel system	.......................................................................................
Wheels (make, size & type)	.......................................................................................
Tyres (make, size & type)	.......................................................................................
Accessories e.g. Air conditioning	.......................................................................................
Build Started	................................. Completion date.............................
	Will your car be on the road in 2009?................................
Build cost or purchase price	.......................................................................................
Registration Number	.......................................................................................

Please put a ring around the area you consider you live:
1. Berks/Bucks/Ox/Hants	6. North East	11. Western
2. Essex	7. North West	12. Yorkshire
3. East Anglia	8. South Coast	13. Scotland
4. London & SE	9. South West	14. Overseas
5. Midlands	10. Wales

Data Protection Act 1998

The information you have provided on this form will be stored on the Clubs membership database, which will be circulated to members during the year. It will not be sold or passed
on to third parties without your permission.

If you DO NOT want your details to be included on the membership list
circulated to members, please put an X in the box.